Chiropractic critical in the UK. Could USA be next?

I hope the public "gets it" someday.

You seem a bit tense. Perhaps you should make an appointment with a chiropractor to loosen you up.

or DO!

I think this is a classic case of taking a few bits of information and using them to fit your assumptions. Have you been to a chiropractor? Certainly some have overstepped their boundaries, but the majority understand their niche, and make a difference in the lives of their patients.

If you look around, you'll see that chiropractors are very successful in the US, and I believe that while their practice is not comprehensive and based on the purest science, it cannot be 100% BS.

In general, being critical is a good thing, but you sound like a Sarah Palin when you make such unchecked blanket statements.

Prove it works or shut up.

IvyHopeful20 said:

Prove it works or shut up.

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My sentiments exactly, but the tens of thousands of practitioners of dubious disciplines can't and won't. Too much money involved.

I agree with Ivy. Can you cite randomized, prospective trials that show chiropractry to be equivalent/superior to medical solutions? Not just phase I/II, I'm asking for phase III trials. If not, I would be hard pressed to say chiropractry works as well, or better, than "Western" medicine.

I do to a chiropractor and have done so for many years and gotten help for problems when traditional medical approaches did nothing to help my pain.

Also, I have an equine chiropractor work on my horses twice yearly. It truly has helped them, especially when my horse who had a really horrible fall and was performing subpar for several months despite seeing the two different vets and being on anti-inflammatory drugs. The day after his first session, his time in barrel racing improved by a full 1.5 seconds.. which is a huge amount when thousandths of a second can mean the difference between a win and loss.

jadealer said:

I do to a chiropractor and have done so for many years and gotten help for problems when traditional medical approaches did nothing to help my pain.

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Most likely any placebo would have worked here.

Also, I have an equine chiropractor work on my horses twice yearly. It truly has helped them, especially when my horse who had a really horrible fall and was performing subpar for several months despite seeing the two different vets and being on anti-inflammatory drugs. The day after his first session, his time in barrel racing improved by a full 1.5 seconds.. which is a huge amount when thousandths of a second can mean the difference between a win and loss. Oh and btw, there was a study in Europe about the ability of chiropractic, massage, and anti-inflammatory drugs to relieve back pain in equine athletes. It was shown that chiropractic yielded the most long term benefit with the fewest side effects. I will have to look to find the paper because i read it a few months ago.

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IF chiros have any place in healthcare, it is w/ musculoskeletal issues. This would make sense then for your horse's injury.

When you find that paper, ensure they have compared efficacy, at minimum, in 4 conditions: control (no Tx), placebo, chiro, medicine. Missing any of those especially placebo and control is a major red flag. d-values are easily inflated when there is no way to compare Tx1 vs. placebo to Tx1 vs. control and placebo vs. control.

apumic said:

When you find that paper, ensure they have compared efficacy, at minimum, in 4 conditions: control (no Tx), placebo, chiro, medicine. Missing any of those especially placebo and control is a major red flag. d-values are easily inflated when there is no way to compare Tx1 vs. placebo to Tx1 vs. control and placebo vs. control.

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Here was the article. My mistake though as it was done at Colorado state University is the #2 vet school in the country not in Europe
Reducing Back Sensitivity

by: Christy West, Digital Editor/Producer
March 30 2008, Article # 11573

Back pain is often suspected in horses, but most treatments haven't been researched much or at all. Results of a study designed to measure the effects of massage, chiropractic, and phenylbutazone (Bute) on back sensitivity were presented at the 2007 American Association of Equine Practitioners Convention, held Dec. 1-5 in Orlando, Fla. Kevin Haussler, DVM, DC, PhD, assistant professor within the Department of Clinical Sciences at Colorado State University, reported on the study. Researchers used pressure algometry (a spring-loaded device with a rubber-tipped plunger that measures applied pressure on a gauge readout) to measure mechanical nociceptive threshold (MNT)--the pressure at which a horse reacts painfully--at several locations along the spine. This method of objective pain assessment is also used in humans to evaluate pain due to fibromyalgia, osteoarthritis, and other conditions. A higher MNT means more pressure is required to elicit a response, so the horse is less sensitive or painful.
Researchers theorized that subclinical back pain is present in all ridden horses, so therapy should lessen that pain and raise MNTs. Thirty-eight healthy adult horses with no history of back pain from four farms were used for this study, which aimed to see which treatment modality raised MNTs the most over the course of a week. The horses were treated as follows:

• Seven horses received Bute (1 g/500 pounds orally every 12 hours) for a week.
• Eight received one chiropractic treatment using a spring-loaded mechanical force instrument at localized regions of joint stiffness, abnormally high muscle tension, or pain (this mechanism ensured a consistent force/velocity of the treatment).
• Eight received one directed massage by a certified massage therapist.
• Seven received no treatment, but continued to be ridden (active controls).
• Eight received no treatment, but were turned out and rested (inactive controls).
• All horses' MNTs were evaluated on Day 0 (before treatment) and at Days 1, 3, and 7 post-treatment.

The results of MNT evaluation on different sites on each horse were pooled for evaluation, and the numbers were somewhat surprising, said Haussler.

• The Bute group actually had a negative response, with 9% and 8% lower MNTs on Days 1 and 3 compared to Day 0. On Day 7, this group had an 8% higher MNT. Bute is much more effective if given when active inflammation is present, noted Haussler.
• Massage was beneficial throughout the study period, with an 8% higher MNT on Day 1, 9% higher on Day 3, and 12% on Day 7.
• Chiropractic resulted in a slight (1%) decrease in MNT on Day 1, an 11% increase on Day 3, and a 27% increase on Day 7 on average.
• Both active and inactive controls' MNTs fluctuated by about 1% across all days.

"We hypothesized that low-grade back pain or inflammation was present in ridden horses, and we found this to be true; otherwise the MNTs would not have increased in all three treatment groups relative to the two control groups," said Haussler. "Massage was beneficial throughout the study; Bute had negative effects for 3 days, then it had a positive effect; and chiropractic had a negative effect on the first day, but then it had the most positive effects.
"Pressure algometry provides an objective tool to evaluate commonly used, but unproven, treatment modalities for the treatment of back pain," he concluded. "Future studies need to evaluate combined treatment effects and long-term MNT changes in horses with documented back pain."

http://www.thehorse.com/ViewArticle.aspx?ID=11573

Hey...better outcomes at day seven with a study with n=8.



In horses.


Color me convinced.

jadealer said:

Here was the article. My mistake though as it was done at Colorado state University is the #2 vet school in the country not in Europe
Reducing Back Sensitivity

by: Christy West, Digital Editor/Producer
March 30 2008, Article # 11573

Back pain is often suspected in horses, but most treatments haven't been researched much or at all. Results of a study designed to measure the effects of massage, chiropractic, and phenylbutazone (Bute) on back sensitivity were presented at the 2007 American Association of Equine Practitioners Convention, held Dec. 1-5 in Orlando, Fla. Kevin Haussler, DVM, DC, PhD, assistant professor within the Department of Clinical Sciences at Colorado State University, reported on the study. Researchers used pressure algometry (a spring-loaded device with a rubber-tipped plunger that measures applied pressure on a gauge readout) to measure mechanical nociceptive threshold (MNT)--the pressure at which a horse reacts painfully--at several locations along the spine. This method of objective pain assessment is also used in humans to evaluate pain due to fibromyalgia, osteoarthritis, and other conditions. A higher MNT means more pressure is required to elicit a response, so the horse is less sensitive or painful.
Researchers theorized that subclinical back pain is present in all ridden horses, so therapy should lessen that pain and raise MNTs. Thirty-eight healthy adult horses with no history of back pain from four farms were used for this study, which aimed to see which treatment modality raised MNTs the most over the course of a week. The horses were treated as follows:

• Seven horses received Bute (1 g/500 pounds orally every 12 hours) for a week.
• Eight received one chiropractic treatment using a spring-loaded mechanical force instrument at localized regions of joint stiffness, abnormally high muscle tension, or pain (this mechanism ensured a consistent force/velocity of the treatment).
• Eight received one directed massage by a certified massage therapist.
• Seven received no treatment, but continued to be ridden (active controls).
• Eight received no treatment, but were turned out and rested (inactive controls).
• All horses' MNTs were evaluated on Day 0 (before treatment) and at Days 1, 3, and 7 post-treatment.

The results of MNT evaluation on different sites on each horse were pooled for evaluation, and the numbers were somewhat surprising, said Haussler.

• The Bute group actually had a negative response, with 9% and 8% lower MNTs on Days 1 and 3 compared to Day 0. On Day 7, this group had an 8% higher MNT. Bute is much more effective if given when active inflammation is present, noted Haussler.
• Massage was beneficial throughout the study period, with an 8% higher MNT on Day 1, 9% higher on Day 3, and 12% on Day 7.
• Chiropractic resulted in a slight (1%) decrease in MNT on Day 1, an 11% increase on Day 3, and a 27% increase on Day 7 on average.
• Both active and inactive controls' MNTs fluctuated by about 1% across all days.

"We hypothesized that low-grade back pain or inflammation was present in ridden horses, and we found this to be true; otherwise the MNTs would not have increased in all three treatment groups relative to the two control groups," said Haussler. "Massage was beneficial throughout the study; Bute had negative effects for 3 days, then it had a positive effect; and chiropractic had a negative effect on the first day, but then it had the most positive effects.
"Pressure algometry provides an objective tool to evaluate commonly used, but unproven, treatment modalities for the treatment of back pain," he concluded. "Future studies need to evaluate combined treatment effects and long-term MNT changes in horses with documented back pain."

http://www.thehorse.com/ViewArticle.aspx?ID=11573

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Effect sizes? p-values? Method of statistical analysis used? Research methods used? Possible confounds and controls for confounds? Supporting literature upon which this experiment was based? Replications of this research? Potential conflicts of interest? Expertise of experimenters?

With such a small sample size, it is unlikely the p-values found were significant. Further, tests of pain, while clinically useful, are often quite dubious as research tools.

Do keep in mind that generally Placebo and Nocebo effects have more research supporting their efficacy in pn mgmt than does Chiro.... Perhaps we need to come up w/ the D.Pl (Doctor of Placebo Therapy)....

jadealer said:

I do to a chiropractor and have done so for many years and gotten help for problems when traditional medical approaches did nothing to help my pain.

Also, I have an equine chiropractor work on my horses twice yearly. It truly has helped them, especially when my horse who had a really horrible fall and was performing subpar for several months despite seeing the two different vets and being on anti-inflammatory drugs. The day after his first session, his time in barrel racing improved by a full 1.5 seconds.. which is a huge amount when thousandths of a second can mean the difference between a win and loss.

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Anecdotes.

It's literally not possible to be more irrelevant.

cdmguy said:

Can anyone see a scenario where the american public "gets it"

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Nope. Just to choose one example of the American public definitively not getting it: in a 2008 Gallup poll, 44% of Americans said they thought the Earth was less than 10,000 years old.

It's annoying to drive around town and see shingles for "DDS; MD; or DPM" and then a group of "Dr.s" I mean, just using the Dr. to me seems like a blatant attempt at deception.

I think the only chriopractors that have a real shot at a successful business are those that market themselves as alternative medicine solutions. They often combine accupunture and massage therapy. Then it's more of a "feel better" thing than a "cure." Meh.

I go to a chiro, but I'm not illusioned into thinking he can save me from anything other than acute misalignment from some odd movement of mine.
I've tried the pain-killer/muscle relaxant route with no avail, one pop from the DC and I was fine.

Now, if I had an ear infection, no I would not call up Dr. DC. I'd call Dr. MD/DO for their assistance.

The point is knowing your use and limitations. Being a DC does not make you superman, just able to make a cool popping noise that feels pretty darn good.

On a side note, as startswithb mentioned, my chiro's office has a person on their door (Dr. Some Lady) that I'm not sure what makes her a doctor...I've been wondering what her "doctor" is in...but she never has tried to manipulate my spine, just my DC. And they are more of a holistic type place, herbs and all that jazz.

I am a college athlete. I have had hip and back problems for most of my life. Pain killers/ muscle relaxers/ anti-inflammatories do nothing for my pain. In high school I saw a chiropractor for it and it helped me get through my workouts. I do believe I would not have been able to get through them without him. In college, our athletic department hires a OMM specialist. That helped me even more.

Don't talk about delicensing chiropractors when they obviously help people. I agree with the person above me that If I have an ear infection, I am going to the doctor. But for sports related pain, I can assure you that this works.

cdmguy said:

Be careful here, just because manipulation (done by any provider-PTs etc not just DCs) helps acute injuries recover faster doesn't mean that it justifies lifetime care or is effective at stabilizing degenerated spines. It's a trap to assign chiropractors credibility based on anecdotes that gives blanket sanction for quackery just because the quackery is a form of manipulation.

Fine distinction.

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The biggest danger of the pseudo-medical practices - be it chiropractic, OMM, homeopathy, naturopathy, etc etc - is that patients can put false faith into their (ineffective) treatment and fail to get proper medical care.

While I wouldn't do it, I'm fine with someone going to a chiropractor to get a back rub to relieve pain. Me, I'd prefer to go to a PT. So long as these pseudo medical practitioners insist on the efficacy of their unprovable quackery, they deserve the pressure and scrutiny they get.

IvyHopeful20 said:

Anecdotes.

It's literally not possible to be more irrelevant.

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Incorrect. Although I agree with you to a point, anecdotes (often more formalized as case studies) have helped pave the way for real advances in understanding, and they are used commonly in medical literature as a starting place before moving on to deeper levels of investigation. They are far from irrelevant. They may end up being incorrect when ascribing causality, but that is far different from irrelevance.

But you just want to be a condescending ass, so I guess it works easier that way. I'm sure you probably realize that there are even less relevant sources of information, but it would cut in on your "cleverness" or whatever it is you were going for with this post.

IvyHopeful20 said:

Hey...better outcomes at day seven with a study with n=8.



In horses.


Color me convinced.

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Although I'd normally not care, since you seem like you're going for major snarky attitude in this thread, I feel the need to be almost as much of an ass as you, and point out that that study looks like it has a far bigger n than 8, but it has groups with an n ~=8. Not a study, study groups.

Especially with so many groups, it's not going to be a huge difference, but even if it were just two groups of 8 being compared, that is already a huge difference, doubling the group size.

..placebo is an amazing thing..

when determining the indications for chiropractic care, just remember: it may be as effective as acetaminophen for low back pain..

cdmguy said:

Trop & Muscle,

I certainly am not disputing that manpulation is an effective tool of therapists for acute musculoskeletal trauma. Research shows it offers good pain relief and speeds healing. However we aren't talking about this. Rather chiropractors do a bait and switch. They get you in the door usually under the premise that they are acting as responsible musculoskeletal therapists for credibility then start with the patient indoctrination (subluxation, lifetime care, etc). But my biggest problem is that if we accept that chiropractic is the provider for treating unstabilized spines then we are stuck because this profession doesn't have the scope or science orientation to accomplish it's mission. So it impedes progress by pretending to serve the niche when it really doesn't. I have the same concern with physical therapists because of their lack of scope. So instead of DCs or PTs I see DOs doing a much better job at it because they have the scope to give prolotherapy to tighten up the weak ligaments and they lack the quackery. Do you see my point?

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I see your point but don't agree. I see both chiropractors and practitioners of osteopathy as quacks, I think they do more harm than good.

sigh, wish people would stop using EBM to boast smarter-than-thou attitudes. Most things in medicine wouldn't be seen as scientifically true if we really did require such rigid guidelines to all research done.

Hell, we wouldn't treat most ear infections or strep throat cases either.

If proper studies aren't done and are lacking in an area, it doesn't mean that something is false, it means that there is no data to establish one position or another. so quit the "i'm right because you can't prove yourself because yoru papers i lacking X Y and Z" when you're not providing a different paper with X, Y, and Z"

And no, I don't see a chiropracter, believe in their practice, or encourage my patients to see them.

Not a big chiropractic supporter.

I went to one for about 4 months because on the first appointment he told me he could make my back problems go away within 3 months. Turn out I had a pinched nerve and he made it a lot worse.

He was either an idiot, which isn't unlikely from how the guy acted, or he was quite the swindler.

denco88 said:

I am a college athlete. I have had hip and back problems for most of my life. Pain killers/ muscle relaxers/ anti-inflammatories do nothing for my pain. In high school I saw a chiropractor for it and it helped me get through my workouts. I do believe I would not have been able to get through them without him. In college, our athletic department hires a OMM specialist. That helped me even more.

Don't talk about delicensing chiropractors when they obviously help people. I agree with the person above me that If I have an ear infection, I am going to the doctor. But for sports related pain, I can assure you that this works.

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OMM is not chiropractory. They may seem similar on the surface but the theory behind it and even the techniques are different. At least there have been attempts to study OMM over the years - the same can't be said about chiropractors. Their basic tenets are very different. One can make more parallels to PT with OMM than chiorpractory.

Kaushik said:

... Can you cite randomized, prospective trials that show chiropractry to be equivalent/superior to medical solutions? Not just phase I/II, I'm asking for phase III trials. If not, I would be hard pressed to say chiropractry works as well, or better, than "Western" medicine.

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This debate should not be so polarizing. Most practitioners, including chiropractors themselves would agree that chiropractic treatment is an alternative form of treatment. Sure, pharmaceutical treatments have clinical trials behind them, but depending on the condition, it makes sense to compliment chemical treatment with mechanical. This mechanical treatment that is such "quackery" is utilized by 22 million people per year (WebMD).

Bottom line for a patient: 1) More options = better. 2) These options will not be considered through p-values or methodology of the latest research, but likely anecdotes -- whether from family, friends, or physician. 3) Mainstream resources such as WebMD or MayoClinic are very clear that chiropractic treatments are alternative/complimentary.

No one is claiming that chiropractic treatments trump Western Medicine, only that they currently are, and should be considered in a patient's options.

cdmguy said:

Trop & Muscle,

I certainly am not disputing that manipulation is an effective tool of therapists for acute musculoskeletal trauma. Research shows it offers good pain relief and speeds healing. However we aren't talking about this. Rather chiropractors do a bait and switch. They get you in the door usually under the premise that they are acting as responsible musculoskeletal therapists for credibility then start with the patient indoctrination (subluxation, lifetime care, etc). But my biggest problem is that if we accept that chiropractic is the provider for treating unstabilized spines then we are stuck because this profession doesn't have the scope or science orientation to accomplish its mission. So it impedes progress by pretending to serve the niche when it really doesn't. I have the same concern with physical therapists because of their lack of scope. So instead of DCs or PTs I see DOs doing a much better job at it because they have the scope to give prolotherapy to tighten up the weak ligaments and they lack the quackery. Do you see my point?

Click to expand...

I get the point, but that it is not the case for all. The DC I go to has worked with me for the issues I face - that's why I go there. The first place I went to did precisely what you mentioned: "I want to see you 5 more times" and gave no explanation as to why. I ditched that fool quickly and found this guy. He's given me exercises to help strengthen muscles in the part of my back that pops out of alignment easily so I have less frequent problems. (Plus, he worked for the local baseball team, so I know he knows something) He never tries to give me information beyond what he knows, he'll refer me to others if I have a question he can't answer.

Not all DCs are doing the bait and switch. The same can be said with MDs/DOs who try to treat beyond their abilities.

Perhaps a better solution instead of removal of the profession would be tighter regulation on the practices and keeping the work within that which it is able to do?

It's sad that the guy I see isn't more common. I know they have information about it, but he never brings it up. Or maybe I just don't pay attention to stuff beyond what I want to- like trying to ignore the religious music playing. Next time I'm in, I'll look around more to see what kind of propaganda they have up in support of your position.

Thanks for the links, when I get a little more time this evening I'll check them out more fully.

Does anyone become a chiro for any other reason than money and wanting to be called Dr.? Or do they "believe" in this stuff prior to school?

I am in my last year of chiropractic school- my institution is evidence based and we are not taught to be primary care providers or heal everything by manipulation- what we are taught is a thorough understanding of pathology and who qualities for adjustments and who does not-we are not taught to run mills and make money- we are not taught to lie or base things in theory that Palmer created 100 years ago- everything is evidence based; treatment protocols, modalities etc.

We also have good working relationships with MD/DO's as we rotate through the hospital here and do rounds with the MD students outside of our clinical rotations- all in effect to see a wider range of patholgies because most in the clinic are not serious or life threatening but you will see those few rare cases, and you should not miss them-

we do more than fix a subluxation- which is, if anyone is wondering, a minor dislocation of the vertebrae in relation to another- there is no secret about it- but it reaches beyond that- diagnosing or spotting for further eval. via CT/MRI spinal pathology( stenosis, degeneration, protrusions, extrusions, sequestrations, lesions, radiculopathy, fractures, tumors, metabolic disorders, vascular disorders, infections, suspect imaging etc.) - we also do extremity adjusting, rehabilitation, nutrition counseling, exercise prescription...we are taught alot, and given a solid foundation as to how to practice and help patients in those aspects of their life-

1.chiropractic is not a cure all- nothing is
2. chiropractic needs to be science based at ALL institutions- beware those that are not- and they often do not have a full encompassing program
3. do not go to chiropractors that talk about spirit, or life fields, or life energy or anything along those lines
4. if you have questions- ask them- and form your own opinions- some people hate medicine and drugs- some people hate chiropractic- both without proper education and understanding first- not all MD's are the same, not all DC's are the same

I read a few of the articles on the chirobase.org collection. I still have more of your articles to go through.

While I understand, and to some extent agree with, your position. I'd be very upset if I couldn't call up the DC to get popped back into place. That doesn't mean I am for the deception that is confronted in the articles and what you are saying, but for the mis-alignments, I like having them around (the good ones). It's a shame that there is a self-propagating cycle of denial instead of just an awakening to what a chiro is able to do. I definitely do not like the simple posting of Dr. X, with no qualifying degree after, which I see at the place I go to.

I looked at the curriculum of where "my" DC went to, which is considered a very good chiro school. (http://www.logan.edu/SubPages.aspx?pID=95&mhID=142&splpID=5) They definitely have medical type courses listed in their clinical phase, along with business classes. Yet, I do see the thorough coursework they have outlined for understanding anatomy and research.

Perhaps he has tried to indoctrinate me, or maybe not - as I explicitly stated what I wanted when I got there and I always asked for more information when he mentioned things. Basically, I've made sure I kept my "treatment" isolated to what I want and not what someone else tells me. That's the same way I treat my interactions with a physician as well. If you tell me I have a problem with X, you need to give me more info and I won't sign up for something until I've done my own research.

Maybe I'm too bullheaded to fall for his jedi mindtricks? Or too oblivious? Or I know enough to know that all he can really do is just put that pesky vertebrae back into spot after I pulled it out?

As with anything, patients need to educate themselves as well and not simply go off of what one person says. I dislike the automatic response of doctor knows everything. I b!tched at my bf for doing that and after I helped him get educated, he's been able to deal with his health issue (not a DC related one, btw).

Sorry for the long post. Thank you for sharing your position, but I hope that you can also see where there is some utility in the profession from those of us who have told you our stories.

I remember my first stroke patient I ever saw was due to some chiropractic maneuver that dislodged a plaque in the carotids- patient stroked out right in the office and never had any workup done by the DC to make rule out any underlying contraindications. Guy was in Neuro ICU for over a week. Never had an opinion about chiro beforehand and mostly negative ones since then.

I don't think I'm dependent upon his manipulations. I go when I need them. When they ask me if I will be back next week, I say, no and I will let them know when I needed service again. I only go to him for one problem, that I've already stated. Being "pushed" towards excess treatments is what made me ditch the guy I had seen prior, again I told the current DC this. Maybe he knows not to try more with me lest he lose all possible business with me (which Logan should have taught him haha). So I go every couple/few months when I've done something stupid, and I'm defending that option. Doesn't make me dependent.

I'm by no means advocating for continual therapy - I'm down for the acute needs. I think it's pretty simple, what's the point of going to someone that keeps pushing you back in place but not making it stay? That's where I agree with the PT/DO route so you can work on developing the things that you need for a condition that requires more continual intervention.

You are a very negative person- which leads me to believe that is why you are not working with patients now- it doesnt matter what field you would have went into- id guess you would have let down many people-

im glad you dont practice- say what you want- im going to be a good DC- the generation of DC's coming out are smarter and more in tune with the reality of the healthcare system-

and yes, my program is young, about 7 years, and the first of it's kind in chiropractic to incorporate research so much- everything we do is research based- every test we take, every examine we do, we are questioned as to why we are doing it and what supports it- and if we dont know, we have to find out or we cant use it.-

your failures dictate your progress- move on and get better, or move over so the stronger people can take over for you.

Ugh. Why do I reply to these things. Someday I'll learn to just ignore this drivel. But you guys make it tough sometimes. I must say, though, that reading through a thread like this is good for a few laughs. The best so far in this thread belongs to Longshanks, with this classic: "OMM is not chiropractory. They may seem similar on the surface but the theory behind it and even the techniques are different. At least there have been attempts to study OMM over the years - the same can't be said about chiropractors. Their basic tenets are very different. One can make more parallels to PT with OMM than chiorpractory." Gee, do you think someone who refers to chiropractic as "chiorpractory" has an expert grasp on the relevant literature?? Laughable.

Cdmguy, you at least seem to have done some reading on this. We can agree that nothing would be more aggravating than a chiro who tells a patient he can cure her lung cancer with 500 chiro treatments. However, out in the real world, there is one sure thing that prevents this kind of stuff: malpractice attorneys. Chiros can get sued for this kind of behavior and every chiro knows that. And I also agree that the "bait and switch" you refer to can be sleazy. BUT, I disagree that these practices are rampant in the chiro profession, and if anything the profession is moving further away from this kind of stuff. Consider getting your info from someone other than a bitter group of failed chiros on chirobase.

Now, cdmguy, to the thrust of your argument: chiropractic manipulation can't help spinal patients because spinal patients have instability because of lax ligaments, and manipulation can't do anything about that. Your solution is to have everyone see a DO for prolotherapy. Now, I'm not dead-set against prolotherapy, but for you to rail against chiros for lack of evidence and then turn around and claim that prolotherapy is the answer is ludicrous! The literature on prolo is spotty at best. You need a new solution my friend. Now more importantly, your assumption that spinal instability is due to lax ligaments is largely incorrect. Sure, in the case of a significant trauma, ligamentous damage and subsequent laxity can be an issue. But this accounts for a tiny fraction of the neck and back pain patients that show up in doctors' offices every day. If your knowledge ran deeper, you would understand that spinal instability is a much more dynamic process that relies more on muscular firing than passive ligamentous stability. You did at least touch upon your superficial grasp of mechanoreception, which is a step in the right direction. But altered mechanoreception does more than just create pain. It alters motor programs, which alters dynamic stability, which causes pain. Manipulation improves mechanoreceptor function, improving afferentation and subsequently improving pain levels and function. And pain isn't everything; we know that people who experience recurrent episodes of back pain (i.e., most people) will still have poor control of their stabilizing musculature even during pain-free between-episode periods, setting them up for future episodes. There's also a growing body of literature looking at the effects of manipulation that go beyond segmental issues and into cortical effects.

There's lots of research out there. You just have to look. It's one thing for someone to say he or she is not familiar with the literature that exists. It's another to make wild proclamations about chiropractic without having any understanding of the science that exists.

If I get time later, I'll address clinical outcomes studies as well as safety issues (including stroke), which is being blown way out of proportion here.

cdmguy said:

It’s always cute when the chiropractors start getting defensive. I guess this thread is a threat because it exposes their litter box.

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Don't flatter yourself. These anti-chiro threads are plentiful around here, and yours is nothing special.

cdmguy said:

This is very misleading. Subluxation care is perfectly legal and codified in most state scopes of practice. The only thing a chiropractor has to do is not promise an outcome and co-manage serious illnesses.

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I've already stated that any unethical tactics are wrong.

cdmguy said:

As for Chirobase, I’m not aware of any failed chiropractors (though I’m sure it’s more convenient for you to personally disparage your critics with ad hominem attacks rather than accept their damning criticisms). It would be just as ludricous to say you can discount James Randi for exposing astrology scams because he isn't a successful astrologer as to shoot down criticism because someone wasn't the owner of a booming chiropractic practice (with the majority based around subluxation quackery). You are insinuating that they are making this stuff up when there is real evidence supporting them. I know the biographies for two of the authors, William Lattanze DC was an osteopathic school student and Sam Homola DC practiced evidence based chiropractic for decades. My main concern with Chirobase is that it follows the defunct NACM/orthopractic model which relies on debunked fixation theory. In this model chiropractors used manipulation to treat fixations ala Motion Palpation technique only when patients has musculoskeletal pain syndromes. It is biomechanically false but a little less abusive than traditional subluxation care.



You misunderstand but I’m glad you see the problem. There is no literature on prolotherapy for the application I am proposing. It has never been tried. Prolotherapists don’t traction shortened ligaments to structurally rehabilitate spines and don’ t use supportive bracing to hold a good neutral position. The research that exists shows that the sclerosing solutions thicken ligaments so it should work. If it doesn’t then at least attention will be directed to discover and innovate a better solution. But to discount a research direction prematurely makes no sense.

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It just struck me as odd that after all the negatives you cast at chiropractic, you would propose a treatment that has next to zero evidence behind it. As I implied, I'm not against prolo as a candidate for future study and as such am not "discounting a research direction prematurely". Currently, prolo is a research direction at best.

cdmguy said:

I don’t buy this at all because of microtrauma. You don’t have to have significant trauma to permanently deform ligaments. This is why sit-ups are now discouraged for abdominal strengthening, they cause repetitive microtrauma to the disks.

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You are entitled to your opinion regarding microtrauma. But current thought is moving toward ligament 'sub-failure'. See http://www.ncbi.nlm.nih.gov/pubmed/16047209 ; Panjabi is a giant in spine research, so you may want to take this into consideration. Also, look into the work of Solomonow's group for more on this.

cdmguy said:

Please post research next time. Your points are very weak, misleading and contradict the literature.

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The knowledge base has been developing over the last couple of decades, involving dozens if not hundreds of studies. No shortcuts here; get crackin' (pun intended). The individual clinical outcomes trials are easier to cite, which I'll do when time permits. The literature supports my position.